Provider Resources

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COVID related Telemedicine policies and billing guidelines


Billing basics: Note, this is for video visits, NOT telephone or portal messaging encounters

     -E/M 99212-99215 (see IPA Matrix for all codes covered per payer)

     -Place of service: 02 for most (see individual payers for specifics)

     -Modifier 95 or GT for synchronous televisits (see list below)

Charting:

     -Consent form on file is mandatory: Sample telemedicine consent form

     -Sample text for chart note: "Synchronous televisit visit performed using Zoom, HIPPA compliant video platform via Charm Health" (this is my system)

AAFP Coronavirus (COVID-19): new telehealth rules and procedure codes for testing 3/10/2020

Portland IPA Virtual Care Matrix: 4/28/3030 Excellent chart of current policies for all local payers

OR/WA Telemedicine Fact Sheet (4/7/2020)

The Doctors Company Telemedicine resources Excellent resource that reviews malpractice, charting, consent, state licensure and privacy


Telemedicine 101 presentation given 3/25/2020 for OPSO


Medicare primary (95, POS 11):  Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020; Update 3/31/2020 from CMS Medicare

Care Oregon:  (95,11)  Medicaid: CPT 99441-99443

United: (95,11) United Health statement  3/14/2020  UHC "more technical" policy  Use CPT 99499, 99421-99423, G2061-G2063

Regence BCBS -(95, 11) Virtual Care policy 9/1/2019. COVID update 3/19/2020 Claims can be submitted on or after Tuesday, March 24, 2020, for dates of service beginning on March 19, 2020.  CPT 99441-99443, 99421-99423, 98966-98969, 99201-99203, 99212-99214, G2012

Aetna:  (Medicare: 95,11; COmmercial GT or 95/02) They will cover telemedicine visits as of 1/1/2020 and waive copay for telemedicine visits until June 4, 2020.  CPT 99201-99215

Cigna: (GT/GQ or 95, 11) -cover telehealth and waive copay until 5/31/2020 CPT 99241 (real time virtual visit) or G2012 (brief tech based communication)

Pacificsource: (GT, 2) waiving all COVID related costs including televisits, copays, etc. until 5/12/2020.  ​CPT 98966, 98969, 99441-99444

Health net: (95, 11) per letter 3/20/2020 they will cover for televisits 3/17-6/30/2020 and waive copay and cost sharing for televisits.  CPT  99201-99203, 99212-99214, G2061-G2063

Providence: (see IPA list as depends on dates and commercial vs medicare) 

Moda (POS 2): policy updated 3/20/2020: they will cover, copay not waived.  Do not use modifier 95 for Medicare Advantage plans.  CPT 99444, 99421-99423

Humana Medicare (GT, POS 2).  CPT 99201-99215, 99421-99423, G0438-G0439

Humana (95, 11)

Kaiser: (OR GT/02 WA 95/02), they will cover, copay not waived

Adventist Health/First Choice: (GT/02) they will cover, copay not waived

HMA: they will cover, copay not waived

MultiPlan/PHCS/Beechstreet: no coverage

Liberty Healthshare: no coverage

Coventry/First health: no coverage

On March 16, 2020, the Secretary, with the concurrence of the Acting DEA Administrator, designated that the telemedicine allowance under section 802(54)(D) applies to all schedule II-V controlled substances in all areas of the United States. Accordingly, as of March 16, 2020, and continuing for as long as the Secretary’s designation of a public health emergency remains in effect, DEA-registered practitioners in all areas of the United States may issue prescriptions for all schedule II-V controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided all of the following conditions are met:

  • The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice;
  • The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system; and
  • The practitioner is acting in accordance with applicable Federal and State laws.

Provided the practitioner satisfies the above requirements, the practitioner may issue the prescription using any of the methods of prescribing currently available and in the manner set forth in the DEA regulations. Thus, the practitioner may issue a prescription either electronically (for schedules II-V) or by calling in an emergency schedule II prescription to the pharmacy, or by calling in a schedule III-V prescription to the pharmacy.

COVID coding

Coding guidance for COVID-19

AAFP Coding for the new coronavirus and COVID-19 illness 3/5/2020


The CDC has released Official Coding Guidance (ICD10) for reporting healthcare encounters related to the 2019 novel coronavirus (COVID-19):

  • Pneumonia, confirmed as due to COVID-19     J12.89, B97.29
  • Acute bronchitis, confirmed as due to COVID-19     J20.8, B97.29
  • Bronchitis NOS, confirmed as due to COVID-19     J40, B97.29
  • Acute/lower respiratory infection NOS, confirmed as due to COVID-19     J22, B97.29
  • Respiratory infection NOS, confirmed as due to COVID-19     J98.8, B97.29
  • Acute respiratory distress syndrome, confirmed as due to COVID-19     J80, B97.29
  • Possible exposure to COVID-19, condition ruled-out     Z03.818
  • Exposure to confirmed COVID-19     Z20.828